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Lieske B, Makarova N, Jagemann B, Walther C, Ebinghaus M, Zyriax BC, Aarabi G. Inflammatory Response in Oral Biofilm during Pregnancy: A Systematic Review. Nutrients 2022; 14:nu14224894. [PMID: 36432584 PMCID: PMC9694722 DOI: 10.3390/nu14224894] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 10/20/2022] [Accepted: 11/15/2022] [Indexed: 11/22/2022] Open
Abstract
Understanding the inflammatory response in oral biofilm during pregnancy and its association with oral and maternal health is essential for identifying biomarker patterns that may serve as markers of pregnancy-related complications. We aimed to conduct a systematic review of the available literature to assess: (1) inflammatory responses in oral biofilm during pregnancy, (2) the association between inflammatory responses in oral biofilm during pregnancy and maternal, oral or systemic conditions, (3) changes in the response of inflammatory biomarkers found in the oral biofilm during different pregnancy stages, and (4) the value of other risk factors such as nutrition and lifestyle. PubMed, Web of Science and Cochrane Library were systematically searched from inception until April 2022. From 5441 records, 39 studies were included for qualitative assessment. The oral biofilm in pregnant women was associated with increased inflammatory biomarkers when compared to non-pregnant women. Levels of inflammatory biomarkers in the oral biofilm were found to be highest in pregnant women with systemic conditions. Increased inflammatory biomarkers in the oral biofilm were also associated with worse oral health outcomes. Given the importance of nutrition and lifestyle for pregnancy and oral health outcomes and the fact that these factors were largely excluded in the included studies, future research should consider a holistic view of the mother during pregnancy to capture physiological, hormonal, immunologic, and metabolic changes in the context of inflammatory responses.
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Affiliation(s)
- Berit Lieske
- Department of Periodontics, Preventive and Restorative Dentistry, Center for Dental and Oral Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, O58, 20246 Hamburg, Germany
- Midwifery Science–Health Care Research and Prevention, Research Group Preventive Medicine and Nutrition, Institute for Health Service Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf, Martinistraße 52, W38, 20246 Hamburg, Germany
- Correspondence:
| | - Nataliya Makarova
- Midwifery Science–Health Care Research and Prevention, Research Group Preventive Medicine and Nutrition, Institute for Health Service Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf, Martinistraße 52, W38, 20246 Hamburg, Germany
| | - Bettina Jagemann
- Midwifery Science–Health Care Research and Prevention, Research Group Preventive Medicine and Nutrition, Institute for Health Service Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf, Martinistraße 52, W38, 20246 Hamburg, Germany
| | - Carolin Walther
- Department of Periodontics, Preventive and Restorative Dentistry, Center for Dental and Oral Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, O58, 20246 Hamburg, Germany
| | - Merle Ebinghaus
- Midwifery Science–Health Care Research and Prevention, Research Group Preventive Medicine and Nutrition, Institute for Health Service Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf, Martinistraße 52, W38, 20246 Hamburg, Germany
| | - Birgit-Christiane Zyriax
- Midwifery Science–Health Care Research and Prevention, Research Group Preventive Medicine and Nutrition, Institute for Health Service Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf, Martinistraße 52, W38, 20246 Hamburg, Germany
| | - Ghazal Aarabi
- Department of Periodontics, Preventive and Restorative Dentistry, Center for Dental and Oral Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, O58, 20246 Hamburg, Germany
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Terzic M, Aimagambetova G, Terzic S, Radunovic M, Bapayeva G, Laganà AS. Periodontal Pathogens and Preterm Birth: Current Knowledge and Further Interventions. Pathogens 2021; 10:pathogens10060730. [PMID: 34207831 PMCID: PMC8227634 DOI: 10.3390/pathogens10060730] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 05/05/2021] [Accepted: 05/24/2021] [Indexed: 12/03/2022] Open
Abstract
Preterm labor is defined as a birth before 37 weeks of gestation and occurs in 5–20% of pregnancies. Preterm labor, as multifactorial entity associated with a high risk of neonatal morbidity and mortality, is influenced by maternal, fetal and environmental factors. Microbiological studies suggest that infectious pathogens may account for 25–40% of preterm birth. Infections of different sites, like genital, urinary tract infections, and pneumonia, are linked to the preterm labor. The most recent epidemiological studies consistently report that maternal periodontal disease is associated with preterm delivery, as well as the association between the presence of pathogenic oral bacteria in the placenta and adverse pregnancy outcomes. On the other hand, some previously published papers found periodontal bacteria in placentas of term pregnancies. In spite of a huge research done on the topic, both experimental and clinical, there are many controversial opinions about the role of periodontal infections in preterm birth. Thus, this comprehensive review addresses this very important topic and evaluates novel strategies of preventive and therapeutic approaches.
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Affiliation(s)
- Milan Terzic
- Department of Medicine, School of Medicine, Nazarbayev University, Nur-Sultan 010000, Kazakhstan; (M.T.); (S.T.)
- Clinical Academic Department of Women’s Health, National Research Center of Mother and Child Health, University Medical Center, Nur-Sultan 010000, Kazakhstan;
- Department of Obstetrics, Gynecology and Reproductive Sciences, School of Medicine, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Gulzhanat Aimagambetova
- Department of Biomedical Sciences, School of Medicine, Nazarbayev University, Nur-Sultan 010000, Kazakhstan
- Correspondence:
| | - Sanja Terzic
- Department of Medicine, School of Medicine, Nazarbayev University, Nur-Sultan 010000, Kazakhstan; (M.T.); (S.T.)
| | - Milena Radunovic
- Laboratory for Microbiology, School of Dental Medicine, University of Belgrade, 11000 Belgrade, Serbia;
| | - Gauri Bapayeva
- Clinical Academic Department of Women’s Health, National Research Center of Mother and Child Health, University Medical Center, Nur-Sultan 010000, Kazakhstan;
| | - Antonio Simone Laganà
- Department of Obstetrics and Gynecology, “Filippo Del Ponte” Hospital, University of Insubria, 21100 Varese, Italy;
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Balan P, Chong YS, Lin Q, Lim TK, Suriyanarayanan T, Udawatte NS, Wong ML, Lopez V, He HG, Seneviratne CJ. Salivary Proteomic Profiling Identifies Role of Neutrophil Extracellular Traps Formation in Pregnancy Gingivitis. Immunol Invest 2021; 51:103-119. [PMID: 33902370 DOI: 10.1080/08820139.2020.1810704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Pregnancy gingivitis peaks during mid-pregnancy and resolves transiently towards the postpartum period. However, the role of maternal immune response in orchestrating gingival inflammation has not yet been fully understood. Hence, in this study, we examined the salivary protein profile during the three trimesters of pregnancy, in context to pregnancy gingivitis, employing iTRAQ-based quantitative proteomics. Unstimulated saliva was collected from 10 subjects in each trimester of pregnancy and postpartum period. Samples were analysed using iTRAQ analysis and ELISA and SEM was performed to validate results. Neutrophil mediated immune response was overrepresented in all three trimesters of pregnancy, despite the decrease in phagocytic responses during the second and third trimesters. ELISA showed a significantly higher Neutrophil Extracellular Traps (NETs) formation in the third trimester of pregnancy coinciding with the resolution of pregnancy gingivitis. The NETs-associated proteins (neutrophil elastase and myeloperoxidase) showed a positive correlation with estrogen hormones, which was also highest during the third trimester. Sex hormone-driven NETs formation could be the mainstay of defence that contributes to the remission of pregnancy gingivitis. This study has provided a new insight into the role of immune-modulation in pregnancy gingivitis, which will aid development of new therapeutics for managing pregnancy gingivitis in future.
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Affiliation(s)
- Preethi Balan
- Singapore Oral Microbiomics Initiative, National Dental Research Institute Singapore, National Dental Center Singapore.,Oral health Academic Clinical Program, Duke NUS Medical School, Singapore
| | - Yap Seng Chong
- Department of Obstetrics and Gynecology, National University Hospital, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore
| | - Qingsong Lin
- Department of Biological Sciences, Faculty of Science, National University of Singapore, Singapore
| | - Teck Kwang Lim
- Department of Biological Sciences, Faculty of Science, National University of Singapore, Singapore
| | - Tanujaa Suriyanarayanan
- Singapore Oral Microbiomics Initiative, National Dental Research Institute Singapore, National Dental Center Singapore.,Oral health Academic Clinical Program, Duke NUS Medical School, Singapore
| | - Nadeeka Shiyamalee Udawatte
- Singapore Oral Microbiomics Initiative, National Dental Research Institute Singapore, National Dental Center Singapore
| | - Mun Loke Wong
- Discipline of Oral Sciences, Faculty of Science, National University of Singapore, Singapore
| | - Violeta Lopez
- School of Nursing, Hubei University of Medicine, Shiyan, China
| | - Hong-Gu He
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Chaminda Jayampath Seneviratne
- Singapore Oral Microbiomics Initiative, National Dental Research Institute Singapore, National Dental Center Singapore.,Oral health Academic Clinical Program, Duke NUS Medical School, Singapore
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4
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Regulation of matrix metalloproteinases-8, -9 and endogenous tissue inhibitor-1 in oral biofluids during pregnancy and postpartum. Arch Oral Biol 2021; 124:105065. [PMID: 33556788 DOI: 10.1016/j.archoralbio.2021.105065] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Revised: 01/12/2021] [Accepted: 01/17/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVE During pregnancy, mothers undergoe considerable physiological changes affecting the whole body including periodontal tissues. Susceptibility to gingival inflammation during pregnancy could be mediated by modulation of matrix metalloproteinases (MMPs) and their tissue inhibitors (TIMPs). Therefore, the aim of this study was to investigate salivary and gingival crevicular fluid (GCF) levels of MMPs and TIMPs during the second and third trimester of pregnancy and postpartum. DESIGN Saliva and GCF samples were collected from 96 pregnant women (PW) before and after giving birth. The sixty matched non-pregnant women (N-PW) were recruited as a control group and full-mouth periodontal examination was performed. The levels of MMP-8, MMP-9 and TIMP-1 were determined by immunofluorometric and enzyme-linked immunosorbent assays. RESULTS The PW group exhibited significantly higher levels of MMP-8 and MMP-9 in their saliva than the N-PW group while corresponding salivary TIMP-1 levels were significantly lower in NPW compared to the postpartum stage. This resulted in significantly higher MMP-8/TIMP-1 and MMP-9/TIMP-1ratio in the saliva from PW before and after birth than in that from N-PW. MMP-8, MMP-9 and TIMP-1 levels were higher in GCF from PW and postpartum than in that from N-PW. CONCLUSIONS MMP-8 and MMP-9 levels in saliva and GCF reflect inflammatory burden during pregnancy. They could be used for monitoring the inflammatory state of gingival tissues during pregnancy.
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Caneiro-Queija L, López-Carral J, Martin-Lancharro P, Limeres-Posse J, Diz-Dios P, Blanco-Carrion J. Non-Surgical Treatment of Periodontal Disease in a Pregnant Caucasian Women Population: Adverse Pregnancy Outcomes of a Randomized Clinical Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E3638. [PMID: 31569780 PMCID: PMC6801449 DOI: 10.3390/ijerph16193638] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 09/22/2019] [Accepted: 09/24/2019] [Indexed: 02/04/2023]
Abstract
AIM To analyze if non-surgical treatment of periodontitis in a pregnant Caucasian women population can reduce adverse pregnancy outcomes. METHODS AND RESULTS A parallel randomized clinical trial was designed and approved by the Ethical Committee of Sanitary Area Santiago-Lugo, Spain (registration number: 2016/451). Forty patients with periodontitis stage II grade B were randomly allocated to receive either comprehensive non-surgical periodontal therapy (test group; n = 20) or professional tooth cleaning (control group; n = 20) before 24 gestational weeks. Randomization was computer-generated by the statistic program Epidat v.4.1 and allocation was performed using sealed opaque envelopes. Clinical measurements and peripheral blood samples for biochemical variables were collected at baseline, in the middle of second trimester before non-surgical treatment, and in the third trimester. Microbiological samples were collected in the second and third trimester. A statistically significant reduction was verified in all clinical and microbiological parameters after periodontal treatment in the test group. No significant differences were observed for the rest of the variables, including preterm birth and/or low birth weight. No adverse events related to periodontal treatment were reported. CONCLUSIONS Non-surgical periodontal treatment in Caucasian patients with periodontitis stage II grade B did not significantly reduce the risk of adverse pregnancy outcomes.
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Affiliation(s)
- Leticia Caneiro-Queija
- Medical-Surgical Dentistry Research Group (OMEQUI), Health Research Institute of Santiago de Compostela (IDIS), University of Santiago de Compostela (USC), 15782 Santiago de Compostela, Spain.
| | - Jose López-Carral
- Medical-Surgical Dentistry Research Group (OMEQUI), Health Research Institute of Santiago de Compostela (IDIS), University of Santiago de Compostela (USC), 15782 Santiago de Compostela, Spain.
- Department of Obstetrics and Gynecology, Clinic University Hospital of Santiago de Compostela, 15782 Santiago de Compostela, Spain.
| | - Pablo Martin-Lancharro
- Medical-Surgical Dentistry Research Group (OMEQUI), Health Research Institute of Santiago de Compostela (IDIS), University of Santiago de Compostela (USC), 15782 Santiago de Compostela, Spain.
- Department of Obstetrics and Gynecology, Clinic University Hospital of Santiago de Compostela, 15782 Santiago de Compostela, Spain.
| | - Jacobo Limeres-Posse
- Medical-Surgical Dentistry Research Group (OMEQUI), Health Research Institute of Santiago de Compostela (IDIS), University of Santiago de Compostela (USC), 15782 Santiago de Compostela, Spain.
- Special Needs Unit, School of Medicine and Dentistry, Santiago de Compostela University, 15782 Santiago de Compostela, Spain.
| | - Pedro Diz-Dios
- Medical-Surgical Dentistry Research Group (OMEQUI), Health Research Institute of Santiago de Compostela (IDIS), University of Santiago de Compostela (USC), 15782 Santiago de Compostela, Spain.
- Special Needs Unit, School of Medicine and Dentistry, Santiago de Compostela University, 15782 Santiago de Compostela, Spain.
| | - Juan Blanco-Carrion
- Medical-Surgical Dentistry Research Group (OMEQUI), Health Research Institute of Santiago de Compostela (IDIS), University of Santiago de Compostela (USC), 15782 Santiago de Compostela, Spain.
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Morelli EL, Broadbent JM, Leichter JW, Thomson WM. Pregnancy, parity and periodontal disease. Aust Dent J 2018; 63:270-278. [PMID: 29770451 DOI: 10.1111/adj.12623] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2018] [Indexed: 12/21/2022]
Abstract
Many women believe that their dental condition deteriorated during pregnancy or as a result of having children. Epidemiological studies have reported an association between higher parity and tooth loss, and higher parity and periodontal attachment loss. Several possible explanations for this association exist. First, hormonal changes during pregnancy affect the immune response to bacterial plaque and drive vascular and gingival changes that may contribute to heightened gingival inflammation. These changes are transient, without irreversible loss of periodontal attachment, and post-partum resolution can be expected for most women. For women with destructive periodontal disease, the effects of pregnancy and parity are unclear. Second, it is also plausible that parity and socioeconomic position (SEP) have shared risk factors, increasing the incidence of disease or influencing its management. Education, one aspect of SEP, is an important determining factor for women's fertility rate, with a gradient of fewer children with higher educational attainment. Higher levels of education are also favourably associated with behaviours conducive to oral health, and a lower incidence of damaging health behaviours. Thus, the potential for confounding is considerable. This review examines the literature on the association between pregnancy, parity and periodontal health, and explores sociobehavioural mechanisms for the observed association.
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Affiliation(s)
- E L Morelli
- The University of Otago - Sir John Walsh Research Institute, Dunedin, New Zealand
| | - J M Broadbent
- The University of Otago - Sir John Walsh Research Institute, Dunedin, New Zealand
| | - J W Leichter
- The University of Otago - Sir John Walsh Research Institute, Dunedin, New Zealand
| | - W M Thomson
- The University of Otago - Sir John Walsh Research Institute, Dunedin, New Zealand
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Shaw L, Harjunmaa U, Doyle R, Mulewa S, Charlie D, Maleta K, Callard R, Walker AS, Balloux F, Ashorn P, Klein N. Distinguishing the Signals of Gingivitis and Periodontitis in Supragingival Plaque: a Cross-Sectional Cohort Study in Malawi. Appl Environ Microbiol 2016; 82:6057-67. [PMID: 27520811 PMCID: PMC5038043 DOI: 10.1128/aem.01756-16] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 07/25/2016] [Indexed: 12/11/2022] Open
Abstract
UNLABELLED Periodontal disease ranges from gingival inflammation (gingivitis) to the inflammation and loss of tooth-supporting tissues (periodontitis). Previous research has focused mainly on subgingival plaque, but supragingival plaque composition is also known to be associated with disease. Quantitative modeling of bacterial abundances across the natural range of periodontal severities can distinguish which features of disease are associated with particular changes in composition. We assessed a cross-sectional cohort of 962 Malawian women for periodontal disease and used 16S rRNA gene amplicon sequencing (V5 to V7 region) to characterize the bacterial compositions of supragingival plaque samples. Associations between bacterial relative abundances and gingivitis/periodontitis were investigated by using negative binomial models, adjusting for epidemiological factors. We also examined bacterial cooccurrence networks to assess community structure. The main differences in supragingival plaque compositions were associated more with gingivitis than periodontitis, including higher bacterial diversity and a greater abundance of particular species. However, even after controlling for gingivitis, the presence of subgingival periodontitis was associated with an altered supragingival plaque. A small number of species were associated with periodontitis but not gingivitis, including members of Prevotella, Treponema, and Selenomonas, supporting a more complex disease model than a linear progression following gingivitis. Cooccurrence networks of periodontitis-associated taxa clustered according to periodontitis across all gingivitis severities. Species including Filifactor alocis and Fusobacterium nucleatum were central to this network, which supports their role in the coaggregation of periodontal biofilms during disease progression. Our findings confirm that periodontitis cannot be considered simply an advanced stage of gingivitis even when only considering supragingival plaque. IMPORTANCE Periodontal disease is a major public health problem associated with oral bacteria. While earlier studies focused on a small number of periodontal pathogens, it is now accepted that the whole bacterial community may be important. However, previous high-throughput marker gene sequencing studies of supragingival plaque have largely focused on high-income populations with good oral hygiene without including a range of periodontal disease severities. Our study includes a large number of low-income participants with poor oral hygiene and a wide range of severities, and we were therefore able to quantitatively model bacterial abundances as functions of both gingivitis and periodontitis. A signal associated with periodontitis remains after controlling for gingivitis severity, which supports the concept that, even when only considering supragingival plaque, periodontitis is not simply an advanced stage of gingivitis. This suggests the future possibility of diagnosing periodontitis based on bacterial occurrences in supragingival plaque.
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Affiliation(s)
- Liam Shaw
- Institute for Child Health, UCL, London, United Kingdom Centre for Mathematics and Physics in the Life Sciences and Experimental Biology, UCL, London, United Kingdom
| | - Ulla Harjunmaa
- Center for Child Health Research, University of Tampere and Tampere University Hospital, Tampere, Finland
| | - Ronan Doyle
- Institute for Child Health, UCL, London, United Kingdom
| | - Simeon Mulewa
- University of Malawi College of Medicine, Blantyre, Malawi
| | - Davie Charlie
- University of Malawi College of Medicine, Blantyre, Malawi
| | - Ken Maleta
- University of Malawi College of Medicine, Blantyre, Malawi
| | - Robin Callard
- Institute for Child Health, UCL, London, United Kingdom
| | | | | | - Per Ashorn
- Center for Child Health Research, University of Tampere and Tampere University Hospital, Tampere, Finland Department of Paediatrics, Tampere University Hospital, Tampere, Finland
| | - Nigel Klein
- Institute for Child Health, UCL, London, United Kingdom
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Madianos PN, Bobetsis YA, Offenbacher S. Adverse pregnancy outcomes (APOs) and periodontal disease: pathogenic mechanisms. J Periodontol 2016; 84:S170-80. [PMID: 23631577 DOI: 10.1902/jop.2013.1340015] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
AIM To evaluate the evidence on potential biological pathways underlying the possible association between periodontal disease (PD) and adverse pregnancy outcomes (APOs). MATERIAL & METHODS Human, experimental and in vitro studies were evaluated. RESULTS Periodontal pathogens/byproducts may reach the placenta and spread to the foetal circulation and amniotic fluid. Their presence in the foeto-placental compartment can stimulate a foetal immune/inflammatory response characterized by the production of IgM antibodies against the pathogens and the secretion of elevated levels of inflammatory mediators, which in turn may cause miscarriage or premature birth. Moreover, infection/inflammation may cause placental structural changes leading to pre-eclampsia and impaired nutrient transport causing low birthweight. Foetal exposure may also result in tissue damage, increasing the risk for perinatal mortality/morbidity. Finally, the elicited systemic inflammatory response may exacerbate local inflammatory responses at the foeto-placental unit and further increase the risk for APOs. CONCLUSIONS Further investigation is still necessary to fully translate the findings of basic research into clinical studies and practice. Understanding the systemic virulence potential of the individual's oral microbiome and immune response may be a distinctly different issue from categorizing the nature of the challenge using clinical signs of PD. Therefore, a more personalized targeted therapy could be a more predictive answer to the current "one-size-fits-all" interventions.
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Affiliation(s)
- Phoebus N Madianos
- Department of Periodontology, School of Dentistry, University of Athens, Athens, Greece.
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9
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Madianos PN, Bobetsis YA, Offenbacher S. Adverse pregnancy outcomes (APOs) and periodontal disease: pathogenic mechanisms. J Clin Periodontol 2016; 40 Suppl 14:S170-80. [PMID: 23627327 DOI: 10.1111/jcpe.12082] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2012] [Indexed: 01/07/2023]
Abstract
AIM To evaluate the evidence on potential biological pathways underlying the possible association between periodontal disease (PD) and adverse pregnancy outcomes (APOs). MATERIAL & METHODS Human, experimental and in vitro studies were evaluated. RESULTS Periodontal pathogens/byproducts may reach the placenta and spread to the foetal circulation and amniotic fluid. Their presence in the foeto-placental compartment can stimulate a foetal immune/inflammatory response characterized by the production of IgM antibodies against the pathogens and the secretion of elevated levels of inflammatory mediators, which in turn may cause miscarriage or premature birth. Moreover, infection/inflammation may cause placental structural changes leading to pre-eclampsia and impaired nutrient transport causing low birthweight. Foetal exposure may also result in tissue damage, increasing the risk for perinatal mortality/morbidity. Finally, the elicited systemic inflammatory response may exacerbate local inflammatory responses at the foeto-placental unit and further increase the risk for APOs. CONCLUSIONS Further investigation is still necessary to fully translate the findings of basic research into clinical studies and practice. Understanding the systemic virulence potential of the individual's oral microbiome and immune response may be a distinctly different issue from categorizing the nature of the challenge using clinical signs of PD. Therefore, a more personalized targeted therapy could be a more predictive answer to the current "one-size-fits-all" interventions.
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Affiliation(s)
- Phoebus N Madianos
- Department of Periodontology, School of Dentistry, University of Athens, Athens, Greece.
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Kose O, Arabaci T, Kara A, Yemenoglu H, Kermen E, Kizildag A, Gedikli S, Ozkanlar S. Effects of Melatonin on Oxidative Stress Index and Alveolar Bone Loss in Diabetic Rats With Periodontitis. J Periodontol 2016; 87:e82-90. [PMID: 26832833 DOI: 10.1902/jop.2016.150541] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The aim of this study is to evaluate the effects of systemic melatonin treatment on serum oxidative stress index (OSI) and alveolar bone loss (ABL) in rats with diabetes mellitus (DM) and periodontitis. METHODS Seventy Sprague Dawley rats were divided into control, experimentally induced periodontitis (EP), DM, EP-DM, EP and melatonin treatment (EP-MEL), DM and melatonin treatment (DMMEL), and EP-DM-MEL groups. DM was induced by alloxan, after which periodontitis was induced by ligature for 4 weeks. After removal of the ligature, the rats in the melatonin groups (EP-MEL, DM-MEL, and EP-DM-MEL) were treated with a single dose of melatonin (10 mg/body weight) every day for 14 consecutive days. At the end of the study, all of the rats were euthanized, and intracardiac blood samples and mandible tissues were obtained for biochemical and histologic analyses. Serum levels of total oxidant status/total antioxidant status and OSI were measured. In addition, neutrophil and osteoclast densities and myeloperoxidase activities were determined in gingival tissue homogenates, and ABL was evaluated with histometric measurements. RESULTS Melatonin treatment significantly reduced fasting plasma glucose levels in the rats with DM. In addition, reduced OSI and ABL levels were detected in the EP-MEL and DM-MEL groups; the reductions in the EP-DM-MEL group were found to be more prominent. Melatonin also significantly decreased the increased myeloperoxidase activities and osteoclast and neutrophil densities in the EP, DM, and EP-DM groups. CONCLUSION It is revealed in this experimental study that melatonin significantly inhibited hyperglycemia-induced oxidative stress and ABL through antiDM and antioxidant effects in rats with DM and periodontitis.
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Affiliation(s)
- Oguz Kose
- Department of Periodontology, Faculty of Dentistry, Recep Tayyip Erdogan University, Rize, Turkey
| | - Taner Arabaci
- Department of Periodontology, Faculty of Dentistry, Ataturk University, Erzurum, Turkey
| | - Adem Kara
- Department of Histology and Embryology, Faculty of Veterinary Medicine, Ataturk University
| | - Hatice Yemenoglu
- Department of Periodontology, Faculty of Dentistry, Recep Tayyip Erdogan University, Rize, Turkey
| | - Eda Kermen
- Department of Periodontology, Faculty of Dentistry, Ataturk University, Erzurum, Turkey
| | - Alper Kizildag
- Department of Periodontology, Faculty of Dentistry, Pamukkale University, Denizli, Turkey
| | - Semin Gedikli
- Department of Histology and Embryology, Faculty of Veterinary Medicine, Ataturk University
| | - Seckin Ozkanlar
- Department of Biochemistry, Faculty of Veterinary Medicine, Ataturk University
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Sorsa T, Gursoy UK, Nwhator S, Hernandez M, Tervahartiala T, Leppilahti J, Gursoy M, Könönen E, Emingil G, Pussinen PJ, Mäntylä P. Analysis of matrix metalloproteinases, especially MMP-8, in gingival crevicular fluid, mouthrinse and saliva for monitoring periodontal diseases. Periodontol 2000 2015; 70:142-63. [DOI: 10.1111/prd.12101] [Citation(s) in RCA: 162] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2015] [Indexed: 12/11/2022]
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12
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Silva N, Abusleme L, Bravo D, Dutzan N, Garcia-Sesnich J, Vernal R, Hernández M, Gamonal J. Host response mechanisms in periodontal diseases. J Appl Oral Sci 2015. [PMID: 26221929 PMCID: PMC4510669 DOI: 10.1590/1678-775720140259] [Citation(s) in RCA: 254] [Impact Index Per Article: 28.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Periodontal diseases usually refer to common inflammatory disorders known as gingivitis and periodontitis, which are caused by a pathogenic microbiota in the subgingival biofilm, including Porphyromonas gingivalis, Aggregatibacter actinomycetemcomitans, Tannerella forsythia and Treponema denticola that trigger innate, inflammatory, and adaptive immune responses. These processes result in the destruction of the tissues surrounding and supporting the teeth, and eventually in tissue, bone and finally, tooth loss. The innate immune response constitutes a homeostatic system, which is the first line of defense, and is able to recognize invading microorganisms as non-self, triggering immune responses to eliminate them. In addition to the innate immunity, adaptive immunity cells and characteristic cytokines have been described as important players in the periodontal disease pathogenesis scenario, with a special attention to CD4+ T-cells (T-helper cells). Interestingly, the T cell-mediated adaptive immunity development is highly dependent on innate immunity-associated antigen presenting cells, which after antigen capture undergo into a maturation process and migrate towards the lymph nodes, where they produce distinct patterns of cytokines that will contribute to the subsequent polarization and activation of specific T CD4+ lymphocytes. Skeletal homeostasis depends on a dynamic balance between the activities of the bone-forming osteoblasts (OBLs) and bone-resorbing osteoclasts (OCLs). This balance is tightly controlled by various regulatory systems, such as the endocrine system, and is influenced by the immune system, an osteoimmunological regulation depending on lymphocyte- and macrophage-derived cytokines. All these cytokines and inflammatory mediators are capable of acting alone or in concert, to stimulate periodontal breakdown and collagen destruction via tissue-derived matrix metalloproteinases, a characterization of the progression of periodontitis as a stage that presents a significantly host immune and inflammatory response to the microbial challenge that determine of susceptibility to develop the destructive/progressive periodontitis under the influence of multiple behavioral, environmental and genetic factors.
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Affiliation(s)
- Nora Silva
- Department of Pathology, Faculty of Dentistry, University of Chile, Santiago, Chile
| | - Loreto Abusleme
- Department of Pathology, Faculty of Dentistry, University of Chile, Santiago, Chile
| | - Denisse Bravo
- Department of Pathology, Faculty of Dentistry, University of Chile, Santiago, Chile
| | - Nicolás Dutzan
- Department of Conservative Dentistry, Faculty of Dentistry, University of Chile, Santiago, Chile
| | - Jocelyn Garcia-Sesnich
- Department of Conservative Dentistry, Faculty of Dentistry, University of Chile, Santiago, Chile
| | - Rolando Vernal
- Department of Conservative Dentistry, Faculty of Dentistry, University of Chile, Santiago, Chile
| | - Marcela Hernández
- Department of Pathology, Faculty of Dentistry, University of Chile, Santiago, Chile
| | - Jorge Gamonal
- Department of Conservative Dentistry, Faculty of Dentistry, University of Chile, Santiago, Chile
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13
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Perunovic ND, Rakic MM, Nikolic LI, Jankovic SM, Aleksic ZM, Plecas DV, Madianos PN, Cakic SS. The Association Between Periodontal Inflammation and Labor Triggers (Elevated Cytokine Levels) in Preterm Birth: A Cross-Sectional Study. J Periodontol 2015; 87:248-56. [PMID: 26447753 DOI: 10.1902/jop.2015.150364] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Periodontitis is considered to be a risk factor for preterm birth. Mechanisms have been proposed for this pathologic relation, but the exact pathologic pattern remains unclear. Therefore, the objective of the present study is to evaluate levels of four major labor triggers, prostaglandin E2 (PGE2), interleukin (IL)-1β, IL-6, and tumor necrosis factor (TNF)-α, in gingival crevicular fluid (GCF) and serum samples between women with preterm birth (PTB) and full-term birth (FTB) and correlate them with periodontal parameters. METHODS PGE2, IL-1β, IL-6, and TNF-α levels were estimated using enzyme-linked immunosorbent assays in GCF and serum samples collected 24 to 48 hours after labor from 120 women (60 FTB, 60 PTB). RESULTS Women with PTB exhibited significantly more periodontitis, worse periodontal parameters, and increased GCF levels of IL-6 and PGE2 compared with the FTB group; there were no significant differences in serum levels of measured markers. GCF levels of IL-1β, IL-6, and PGE2 and serum levels of TNF-α and PGE2 were significantly higher in women with periodontitis compared with periodontally healthy women. Serum levels of PGE2 were positively correlated with probing depth (PD) and clinical attachment level (CAL) as well as with GCF levels of TNF-α in women with PTB. CONCLUSIONS Women with PTB demonstrated worse periodontal parameters and significantly increased GCF levels of IL-6 and PGE2 compared with those with FTB. Based on significant correlations among serum PGE2 and PD, CAL, and GCF TNF-α in PTB, periodontitis may cause an overall increase of labor triggers and hence contribute to preterm labor onset.
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Affiliation(s)
- Neda Dj Perunovic
- Department of Periodontology and Oral Medicine, Faculty of Dental Medicine, University of Belgrade, Belgrade, Serbia
| | - Mia M Rakic
- Institute for Biological Research "Sinisa Stankovic," University of Belgrade.,Centre for Osteoarticular and Dental Tissue Engineering, INSERM U791, Faculty of Dental Surgery, University of Nantes, Nantes, France
| | - Ljubinka I Nikolic
- Clinic for Gynecology and Obstetrics, Clinical Center of Serbia, Belgrade, Serbia
| | - Sasa M Jankovic
- Department of Periodontology and Oral Medicine, Faculty of Dental Medicine, University of Belgrade, Belgrade, Serbia
| | - Zoran M Aleksic
- Department of Periodontology and Oral Medicine, Faculty of Dental Medicine, University of Belgrade, Belgrade, Serbia
| | - Darko V Plecas
- Clinic for Gynecology and Obstetrics, Clinical Center of Serbia, Belgrade, Serbia
| | - Phoebus N Madianos
- Department of Periodontology, School of Dentistry, University of Athens, Hellas, Greece
| | - Sasa S Cakic
- Department of Periodontology and Oral Medicine, Faculty of Dental Medicine, University of Belgrade, Belgrade, Serbia
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14
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Arabacı T, Kermen E, Özkanlar S, Köse O, Kara A, Kızıldağ A, Duman ŞB, Ibişoğlu E. Therapeutic Effects of Melatonin on Alveolar Bone Resorption After Experimental Periodontitis in Rats: A Biochemical and Immunohistochemical Study. J Periodontol 2015; 86:874-81. [PMID: 25812911 DOI: 10.1902/jop.2015.140599] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The present study aims to investigate the effects of systemic melatonin administration on alveolar bone resorption in experimental periodontitis in rats. METHODS Twenty-four male Sprague-Dawley rats were divided into three groups (control, experimental periodontitis [Ped], and experimental periodontitis treated with melatonin [Mel-Ped]). For periodontitis induction, first molars were ligatured submarginally for 4 weeks. After ligature removal, rats in the Mel-Ped group were treated with a daily single dose of 10 mg/kg body weight melatonin for 15 consecutive days. At the end of the study, intracardiac blood samples and mandible tissues were obtained for histologic, biochemical, and radiographic analysis. Serum markers related to bone turnover, calcium, phosphorus, bone alkaline phosphatase (b-ALP), and terminal C telopeptide of collagen Type I (CTX) were analyzed. Myeloperoxidase levels were determined in gingival tissue homogenates, and receptor activator of nuclear factor-kappa B ligand (RANKL) activation was analyzed in the mandible samples stereologically. Alveolar bone loss was also evaluated radiographically in the mandible samples of each group. RESULTS Melatonin treatment decreased serum CTX levels and increased b-ALP levels. Serum calcium and phosphorus levels were not statistically different among groups (P >0.05). Alveolar bone resorption and myeloperoxidase activity were statistically higher in the Ped group compared to the Mel-Ped group (P <0.05). Immunohistochemical staining of RANKL and osteoclast activity were significantly lower in the Mel-Ped group compared to the Ped group (P <0.05). CONCLUSION This study reveals that melatonin treatment significantly inhibits regional alveolar bone resorption and contributes to periodontal healing in an experimental periodontitis rat model.
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Affiliation(s)
- Taner Arabacı
- Department of Periodontology, Faculty of Dentistry, Atatürk University, Erzurum, Turkey
| | - Eda Kermen
- Department of Periodontology, Faculty of Dentistry, Atatürk University, Erzurum, Turkey
| | - Seçkin Özkanlar
- Department of Biochemistry, Faculty of Veterinary Medicine, Atatürk University
| | - Oğuz Köse
- Department of Periodontology, Faculty of Dentistry, Recep Tayyip Erdogan University, Rize, Turkey
| | - Adem Kara
- Department of Histology and Embryology, Faculty of Veterinary Medicine, Atatürk University
| | - Alper Kızıldağ
- Department of Periodontology, Faculty of Dentistry, Atatürk University, Erzurum, Turkey
| | - Şuayip Burak Duman
- Department of Oral Diagnosis and Radiology, Faculty of Dentistry, Atatürk University
| | - Ebru Ibişoğlu
- Department of Nuclear Medicine, Faculty of Medicine, Atatürk University
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15
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Walia M, Saini N. Relationship between periodontal diseases and preterm birth: Recent epidemiological and biological data. Int J Appl Basic Med Res 2015; 5:2-6. [PMID: 25664259 PMCID: PMC4318095 DOI: 10.4103/2229-516x.149217] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Accepted: 06/27/2014] [Indexed: 11/10/2022] Open
Abstract
Preterm infants are born prior to completion of 37 weeks of gestation. These patients are seen on the rise despite the efforts put in to control them. Global incidence of preterm birth is around 9.6% of all birth representing 12.9 million births with regional disparities: From 12% to 13% in USA, from 5% to 9% in Europe, and 18% in Africa. First reported by Offenbacher et al. in 1996 relationship exist between maternal periodontal disease and delivery of a preterm infant. This article reviews the recent epidemiological and biological data. The articles were searched on Google, PubMed recent articles were selected. Mainly, three hypotheses by which periodontal bacteria can affect the outcome of pregnancy. Biological hypothesis: (a) Bacterial spreading, (b) Inflammatory products dissemination, (c) Role of fetomaternal immune response against oral pathogens. The promotion of the early detection and treatments of periodontal disease in young women before and during pregnancy will be beneficial especially for women at risk.
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Affiliation(s)
- Moneet Walia
- Department of Gynecology and Obstetrics, Christian Medical College, Ludhiana, Punjab, India
| | - Navdeep Saini
- Department of General Surgery, Christian Medical College, Ludhiana, Punjab, India
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16
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Gürsoy M, Zeidán-Chuliá F, Könönen E, Moreira JCF, Liukkonen J, Sorsa T, Gürsoy UK. Pregnancy-induced gingivitis and OMICS in dentistry: in silico modeling and in vivo prospective validation of estradiol-modulated inflammatory biomarkers. OMICS-A JOURNAL OF INTEGRATIVE BIOLOGY 2014; 18:582-90. [PMID: 24983467 DOI: 10.1089/omi.2014.0020] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Pregnancy-associated gingivitis is a bacterial-induced inflammatory disease with a remarkably high prevalence ranging from 35% to 100% across studies. Yet little is known about the attendant mechanisms or diagnostic biomarkers that can help predict individual susceptibility for rational personalized medicine. We aimed to define inflammatory proteins in saliva, induced or inhibited by estradiol, as early diagnostic biomarkers or target proteins in relation to pregnancy-associated gingivitis. An in silico gene/protein interaction network model was developed by using the STITCH 3.1 with "experiments" and "databases" as input options and a confidence score of 0.700 (high confidence). Salivary estradiol, interleukin (IL)-1β and -8, myeloperoxidase (MPO), matrix metalloproteinase (MMP)-2, -8, and -9, and tissue inhibitor of matrix metalloproteinase (TIMP)-1 levels from 30 women were measured prospectively three times during pregnancy and twice during postpartum. In silico analysis revealed that estradiol interacts with IL-1β and -8 by an activation link when the "actions view" was consulted. In saliva, estradiol concentrations associated positively with TIMP-1 and negatively with MPO and MMP-8 concentrations. When the gingival bleeding on probing percentage (BOP%) was included in the model as an effect modifier, the only association, a negative one, was found between estradiol and MMP-8. Throughout gestation, estradiol modulates the inflammatory response by inhibiting neutrophilic enzymes, such as MMP-8. The interactions between salivary degradative enzymes and proinflammatory cytokines during pregnancy suggest promising ways to identify candidate biomarkers for pregnancy-associated gingivitis, and for personalized medicine in the field of dentistry. Finally, we call for greater investments in, and action for biomarker research in periodontology and dentistry that have surprisingly lagged behind in personalized medicine compared to other fields, such as cancer research.
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Affiliation(s)
- Mervi Gürsoy
- 1 Department of Periodontology, Institute of Dentistry, University of Turku , Turku, Finland
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17
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Figuero E, Carrillo-de-Albornoz A, Martín C, Tobías A, Herrera D. Effect of pregnancy on gingival inflammation in systemically healthy women: a systematic review. J Clin Periodontol 2013; 40:457-73. [PMID: 23557432 DOI: 10.1111/jcpe.12053] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2012] [Revised: 11/14/2012] [Accepted: 11/30/2012] [Indexed: 11/29/2022]
Abstract
AIM To obtain an overall quantitative estimate of the association between pregnancy and gingival inflammation. MATERIAL AND METHODS Medline and EMBASE databases were searched through August 2011. Prospective cohort or cross-sectional studies assessing the effect of pregnancy on gingival inflammation evaluated by the gingival index (GI) and/or bleeding on probing were included. Meta-analyses were performed if possible. RESULTS Forty-four articles representing 33 studies (14 cohort and 19 cross-sectional) were included. Meta-analyses, performed whenever possible, revealed (1) a significantly lower GI in pregnant women in the first term compared with those in their second or third term of pregnancy; (2) a lower mean GI score in post-partum women compared with women in their second [WMD = 0.143; 95% CI (0.031; 0.255); p = 0.012] or third term [WMD = 0.256; 95% CI (0.151; 0.360); p < 0.001] of pregnancy, when considering cohort studies; (3) Non-pregnant women had lower mean GI values than women in their second or third term of pregnancy. Small changes in plaque levels were reported. CONCLUSION Despite the limited number of studies included in the meta-analyses, the present systematic review confirms the existence of a significant increase in GI throughout pregnancy and between pregnant versus post-partum or non-pregnant women, without a concomitant increase in plaque levels.
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Affiliation(s)
- Elena Figuero
- Section of Graduate Periodontology, University Complutense, Madrid, Spain.
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18
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Akman S, Canakci V, Kara A, Tozoglu U, Arabaci T, Dagsuyu İM. Therapeutic Effects of Alpha Lipoic Acid and Vitamin C on Alveolar Bone Resorption After Experimental Periodontitis in Rats: A Biochemical, Histochemical, and Stereologic Study. J Periodontol 2013; 84:666-74. [DOI: 10.1902/jop.2012.120252] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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19
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Análisis de MMPs en fluidos orales en el diagnóstico complementario de las enfermedades periodontales. ACTA ACUST UNITED AC 2012. [DOI: 10.1016/s0718-5391(12)70111-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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20
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Relationship between periodontal diseases and preterm birth: recent epidemiological and biological data. J Pregnancy 2011; 2011:164654. [PMID: 22132334 PMCID: PMC3205685 DOI: 10.1155/2011/164654] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2011] [Accepted: 10/03/2011] [Indexed: 01/02/2023] Open
Abstract
For ten years, the incidence of preterm birth does not decrease in developed countries despite the promotion of public health programs. Many risk factors have been identified including ethnicity, age, tobacco, and infection. However, almost 50% of preterm birth causes remain unknown. The periodontal diseases are highly prevalent inflammatory and infectious diseases of tooth supporting tissues leading to an oral disability. They influence negatively general health worsening cardiovascular diseases and diabetes. Periodontal diseases have been also suspected to increase the rate of preterm birth, but data remain contradictory. The objective of this review is to present the principal results of epidemiological, biological, and interventional studies on the link between periodontal diseases and preterm birth. The conclusions of this work underline the importance for the physician/obstetrician to identify women at risk for preterm birth and to address these patients to dentist for periodontal examination and treatment in order to limit adverse pregnancy outcomes.
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